[Real life clinical management of nonvalvular atrial fibrillation: results from the Italian epidemiological survey eXperience on the use of rivaroxaban].

BACKGROUND: Atrial fibrillation-related stroke prevention with anticoagulant drugs is currently evolving towards the introduction into clinical practice of the new oral anticoagulants, including rivaroxaban. Our aim was to evaluate in a real-life setting the characteristics and management of patients with nonvalvular atrial fibrillation to whom Italian doctors decided to prescribe rivaroxaban.

METHODS: Between January and February 2014, a group of 95 physicians collected aggregate retrospective data, through an online questionnaire, on 1127 patients with nonvalvular atrial fibrillation receiving rivaroxaban. Descriptive statistics were performed based on the data collected.

RESULTS: Mean age of patients was 76 years; 20% of patients suffered a previous transient ischemic attack and 16% a previous stroke; 16% was anemic or at risk of bleeding. Over 40% of patients was unable to have a good control of the previous antithrombotic therapy, 22% was also taking antiplatelet drugs or nonsteroidal anti-inflammatory drugs, and 85% had been on a previous stroke prevention therapy; among the latter the main causes for switching to rivaroxaban were patient choice (30%), problems in maintaining the prothromin time-international normalized ratio (PT-INR) within the therapeutic range (27%), and logistic problems in attending the PT-INR follow-up visits (20%). Rivaroxaban was prescribed at a dosage of 15 mg in 37.8% of patients and 20 mg in 62.2%; the 15 mg dose was prescribed to 264 of 354 patients with creatinine clearance <50 ml/h (74.6%) and in older patients with more comorbidities.

CONCLUSIONS: In this real-life analysis, patient characteristics were similar to those of patients enrolled in large randomized trials, whereas differences in dose prescriptions were observed.